Study Links Corticosteroids to PEG Tube Complications

The rate of major complications related to percutaneous endoscopic gastrostomy (PEG) tubes more than doubled when dogs and cats received corticosteroids than when they did not, according to a single-center retrospective study.

Fully 43% of patients on steroids developed a major PEG-related complication—such as purulent discharge at the stoma site, or tube dislodgment—compared with 18% of controls (P = .05), reported Joana Aguilar, DVM, MRCVS, of the Queen Mother Hospital for Animals in London, United Kingdom. In contrast, minor PEG-related complications—such as serous discharge or inflammation at the stoma site—appeared to be unrelated to steroid treatment, she and her associates said.

Both enteral nutrition and corticosteroids are used to treat a variety of inflammatory, neoplastic, immune-mediated, and neurologic diseases, Dr. Aguilar and her associates noted. The problem is that corticosteroids not only suppress inflammation, but inhibit wound healing by hindering fibroblast proliferation. To understand whether this effect contributes to veterinary PEG-related complications, they reviewed records from dogs and cats with PEG tubes in use at their hospital for at least 24 hours between 1996 and 2015. Among 42 such patients, 14 animals (12 dogs and two cats) received concomitant corticosteroids, while the rest (26 dogs and two cats) did not, and were considered controls.

The chances of any type of complication were numerically higher (78%) among animals that received steroids compared with controls (57%), said the researchers. That difference did not reach statistical significance, perhaps due to the fact that the study was substantially underpowered, they noted. Likewise, individual rates of stoma site infections and tube dislodgement were higher among patients receiving corticosteroids than controls, although the difference was not statistically significant.

Indications for PEG placement varied widely, but patients most often had renal disease, autonomic nervous system disorders, gastrointestinal ulcerations, esophageal strictures, pharyngeal dysphagia, or megaesophagus, the investigators found. The two groups were similar in terms of age, year of treatment, body weight, and body condition score. The steroid group received an average of 24 days of enteral nutrition, compared with 13 days for controls (P = .04), but the worst complications occurred at similar time points.

“Different conditions require different corticosteroid protocols, and each treatment plan should be adjusted to patient’s needs,” Dr. Aguilar and her associates commented. But when planning PEG for patients on corticosteroids, veterinarians should notify owners about the potential for complications “beyond those normally associated with PEG tube usage alone,” they concluded.

Dr. Amy Karon earned her doctorate in veterinary medicine and master’s degrees in public health and journalism from the University of Wisconsin-Madison. She was an infectious disease epidemiologist and “disease detective” (EIS officer) with the Centers for Disease Control and Prevention before becoming a full-time medical writer. She lives in the San Francisco Bay area, where she volunteers for the local Humane Society.